Limitations
In this study we used USS to diagnose NAFLD instead of the gold standard liver biopsy. USS is a non-invasive, acceptable and feasible alternative method, especially in pregnant women. The sensitivity of the diagnosis of fatty liver in ultrasound scans ranges from 60-94%, and the specificity is from 84-95%. The sensitivity of detecting fatty liver is increased when the degree of fatty liver is increased. In morbid obesity, sensitivity and specificity are reduced from 49-75% due to technical errors. However, evidence shows that the reliability of USS for diagnosing fatty liver is higher than that of histology in people with moderate and severe fatty liver. In addition, the grading of fatty liver is subjective and operator-dependent 12. The objective of the FL scan in our study is risk prediction rather than a precise diagnosis of steatosis, and for that purpose, routine USS will be adequate.
The wide confidence intervals are due to the relatively low number of GDM reported show the need for a study with a larger sample size for better estimates of risk. Application of latest WHO criteria37 led to exclusion of 66 pregnant women from the baseline assessment whom should not be excluded if the previous classification was used.